Climactauria

BY MARK SCHOLZ, MD

Some men—unfortunately, only a minority—are genuinely pleased after prostate surgery.  Their erections are maintained, cancer is gone and they don’t leak urine. The excitement of surviving an operation with one’s manhood intact often leads to euphoria with repeated public declarations about the wonders of surgery:  “Come on in,” they say, “The water’s fine!”

In reality, there is no “good” treatment for prostate cancer. Sure, some men can luck out and are happy to talk about it. But more frequently, when men are asked how they are doing after surgery, they say they are fine, even when they are not. No man likes going public about his lost sexuality.  And there is little value in bemoaning what can’t be changed.

So, does it make any difference which treatment is chosen?  Is radiation any better?

Here is my estimate of the latest stats for a 65 year old with Intermediate-Risk prostate cancer with normal sexual and urinary function treated with either state-of-the-art surgery or radiation therapy administered by a world class surgeon or radiation therapist:

	Surgery	Radiation
Cure Rate	80%	85%
Impotence	50%	35%
Incontinence	8%	1%
Urinary Bother	2%	25%
Rectal Burn	0%	1%
Climactauria	12%	0%

As you can see, radiation has its own problems, particularly with what is termed, “urinary bother.” Bother can mean urgency, a need to go RIGHT NOW.  It can mean frequency, making multiple trips to the bathroom throughout the day. It can mean nocturia, having to urinate frequently at night.  Rectal burns are even more disastrous with unremitting pain, bleeding and leakage.  Fortunately this healthcare disaster is quite rare.

What is climactauria?  Ejaculating urine instead of semen.  One of the world’s top surgeons, Herbert Lepor from New York University reported on the incidence of climactauria in 1,459 men he treated with radical prostatectomy between 2001 to 2007. The percentage of men reporting any degree of climactauria 24 months after surgery was 36%.  The percentage reporting severe climactauria after 24 months was 12%. The stats in less eminent surgeons are probably worse.

Men contemplating surgery or radiation need to review the stats.  Both surgery and radiation are unappealing.  However, to my way of thinking, if a man’s conditionsdictates a need for treatment, skillful radiation appears less daunting than skillful surgery.